1. Rochester Regional Health Informational Management Association Preparing for ICD-10: Changes in Emergency Medicine
September 24, 2015
Keith Grams, MD
Chief, Emergency Medicine
Associate CMO, throughput & Capacity Management
Rochester General Health System

2. Objectives:
To review the primary changes ICD-10 will bring to Emergency Medicine
To demonstrate the charting process
To review the current preparation
To understand the potential impact of ICD-10 on patient care

3. Quick Quiz
When was ICD-9 adopted?
1979

4. Quick Quiz
Who created ICD-10?
The World Health Organization

5. Quick Quiz What does ICD stand for?
International Statistical Classification of Diseases and Related Health Problems
ISCODARHP
ICD

6. Quick Quiz
When was ICD-10 adopted by WHO?
1994

7. Quick Quiz
When was ICD-10 first supposed to go-live in the US?
2013

8. Quick Quiz
When is ICD-10 going live in the US?
October 1, 2015

9. Changes in EM (Professional)
Charting in Epic
(CareConnect)

10. How We Teach the Providers
Documentation
Communication
Coding
Medico-legal

11. ED Professional Coding
Relative Value Unit
Medicare
Omnibus Budget Reconciliation Act, 1989

12. The Game

13. The TrackBoard

14. The Chart

15. HPI

16. HPI

17. HPI

18. HPI

19. ROS

20. Physical Exam

21. Procedures

22. Procedures

23. Medical Decision Making

24. Attestation Tab

25. The Note

26. What’s Missing?

27. What’s Missing?

28. What Missing? Past medical/surgical history Social history
Family history

29. Orders

30. Orders

31. Orders: Indications

32. Diagnosis “Clinical Impression”

33. Diagnosis “Clinical Impression”
ICD-9
ICD-10
17,000
141,000

34. Diagnosis “Clinical Impression”

35. Diagnosis “Clinical Impression”

36. Diagnosis “Clinical Impression”

37. Diagnosis “Clinical Impression”

38. Diagnosis “Clinical Impression”
Detail, detail, detail
Initial, subsequent, sequela
Location, location, location
Abdominal pain
Contusions, sprains,…

39. Current preparation

40. What’s Been Done? RRH Online education HLC modules
Coding company education
On line modules
Direct feedback loop
Dual coding deficiencies

41. What Happens When We See Data?
1. Denial/Blame
2. Anger
3. Bargaining
4. Depression
5. Acceptance

42. Stages of Data Grief 1. Denial/Blame 2. Anger 3. Bargaining
4. Depression
5. Acceptance

43. Coping with Loss …
Deficiencies
Charts %
Department
100
1000
10%

44. Coping with Loss … Deficiencies Charts % Dr. A 250 0% Dr. B Dr. C
250 0%
Dr. B
Dr. C
Dr. D
100
40%

45. Coping with Loss … Deficiencies Charts % Dr. Bentley 250 0%
250 0%
Dr. Benziger
Dr. Cavallaro
Dr. Grams
100
40%

46. Are We Ready?
Dual coding feedback …

47. Are We Ready? 2015 Batch# Coded Defiencies % 1 570 24 4.21% 2 302
0.33% 3
128
0.00% 4 96 5 42 6 75

48. Deficiencies

49. Deficiencies

50. Deficiency Breakdown 0.7% of all charts # Percentage Total 24 100%
Location 13
54%
Type 3
13%
JPW 8
33%
0.7% of all charts

51. Now We’re Ready

52. Impact on Patient Care

53. 22,000 more than next largest ED in area
Volume
2014 = 125,323
2015 = 128,000+
2014:
22,000 more than next largest ED in area

54. Door-to-Provider

55. LWO

56. How We Keep Up Team triage model CareConnect optimization ASAP tools
Documentation
Scribes

57. 66 minutes (of clicking) in 12 hr shift
What Does the EMR Cost?
4,000 clicks/shift
1 click/sec
66 minutes (of clicking) in 12 hr shift

58. What Does the EMR Cost? For RGH
13.2 hours/day of clicking
26.5 pt/day not seen
9665 pt/yr not seen
Cost of EMR = $966,574

59. EMR Pro’s & Con’s Con’s Time away from the patient
Operational challenges
Availability of information
Pro’s
Integration
Data …

60. Coming Soon … Previous based on general EMR numbers
No RGH specific data…
Usage data coming soon

61. Recap: EM changes in ICD-10 The charting process Current preparation
EMR impact on patient care